Provider Demographics
NPI:1467518563
Name:REESE, SALLY JEROME (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:JEROME
Last Name:REESE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CREDENTIALS OFFICE
Mailing Address - Street 2:CMR 442
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09042
Mailing Address - Country:US
Mailing Address - Phone:49622-117-2274
Mailing Address - Fax:49622-117-2941
Practice Address - Street 1:HEIDELBERG MEDDAC
Practice Address - Street 2:CMR 442
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09042
Practice Address - Country:US
Practice Address - Phone:49622-117-2274
Practice Address - Fax:49622-117-2941
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001144395163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical